Tuesday, May 23, 2017

TB Travels

"Health agency spends more on travel than on AIDS" by Associated Press May 22, 2017

LONDON — The United Nations health agency has routinely spent about $200 million a year on travel expenses, more than what it doles out to fight some of the biggest problems in public health, including AIDS, tuberculosis, and malaria combined, according to internal documents.

Last year, the World Health Organization spent about $71 million on AIDS and hepatitis. It devoted $61 million to malaria. To slow the spread of tuberculosis, WHO invested $59 million. Some health programs do get exceptional funding — the agency spends about $450 million trying to wipe out polio every year.

Dr. Margaret Chan, director-general of the WHO, traveled to Guinea this month to join the country’s president in celebrating the world’s first Ebola vaccine.After praising health workers in West Africa for their triumph over the lethal virus, Chan spent the night in the top-tier presidential suite at the beachside Palm Camayenne hotel. The suite, equipped with marble bathrooms and a dining room that seats eight, has an advertised price of $1,000 per night.WHO declined to say if it paid for Chan’s stay at the Palm Camayenne in Conakry, but noted that host countries sometimes pick up the tab for her hotels.

At a time when the cash-strapped agency is pleading for money to fund its responses to health crises worldwide, it has struggled to curb travel costs.

Senior officials have complained internally that UN staffers break new rules that were introduced to curb expansive travel spending, booking perks like business class plane tickets and rooms in five-star hotels with few consequences.

‘‘We don’t trust people to do the right thing when it comes to travel,’’ Nick Jeffreys, WHO’s director of finance, said during a September 2015 in-house seminar on accountability — a video of which was obtained by the Associated Press.Despite WHO’s numerous travel regulations, Jeffreys said staffers ‘‘can sometimes manipulate a little bit their travel.’’ The agency couldn’t be sure people on its payroll always booked the cheapest fares or that their travel was even warranted, he said.‘‘People don’t always know what the right thing to do is,’’ Jeffreys said.Ian Smith, executive director of Chan’s office, said the chair of WHO’s audit committee said the agency often did little to stop misbehavior.Earlier that year, a memorandum was sent to Chan and other top leaders with the subject line ‘‘actions to contain travel costs’’ written in capital letters. The memo reported that compliance with rules requiring travel to be booked in advance was ‘‘very low.’’ The document also pointed out that WHO was under pressure from its member countries to save money.

In a statement, the agency said ‘‘the nature of WHO’s work often requires WHO staff to travel’’ and that costs were reduced 14 percent last year compared to the previous year — although that year’s total was exceptionally high due to Ebola outbreak in West Africa.

"Lynn clinic works to bring tuberculosis out of hiding" by Felice J. Freyer Globe Staff February 21, 2017

LYNN — Antonio Frias has a TB infection that he may have carried, without knowing it, since before he left the Dominican Republic 30 years ago. His case was detected because the health center is taking a rare, aggressive approach to tuberculosis by identifying and treating infected people before they become sick.

And a recent $1.5 million federal grant to the Massachusetts Department of Public Health — the only one awarded in the country — will vastly expand that effort.

Tuberculosis, one of humankind’s oldest foes, has been killing people for tens of thousands of years and today infects one-third of the world’s population. It can attack any part of the body, but most often starts in the lungs, leading to bloody coughs, weakness, fever, and night sweats. But tuberculosis is little seen and little understood in the United States, where it is often misdiagnosed as pneumonia.

Treating active TB is an expensive ordeal, costing $17,000 per person, on average. Depending on how sick they are, patients often need to be hospitalized or isolated. They must take as many as nine pills a day for nine months or longer, and a public health nurse visits every day to make sure they do so. Failure to take all the medication until the infection is stamped out can lead to strains of tuberculosis that are resistant to medications, a big problem overseas. In contrast, latent TB can be treated with one or two drugs taken for four months, at an average cost of $500 per person.

In Lynn, the main medical provider for a city of immigrants, one-third of Lynn’s population is foreign-born, with most coming from countries where tuberculosis is endemic. Across the country, about two-thirds of tuberculosis cases occur in people born overseas.That's what comes with being a sanctuary state -- and they blame Trump for the health costs!

Still, it was an American-born doctor whose illness helped the city get ready. In 2015, a Lynn Community Health Center physician, Dr. Kelly John Holland, developed an active case of TB.

“That triggered hysteria in the community,” Haptu said, because the doctor had come in contact with so many people. The health center ended up screening more than 1,000 contacts.

While traumatic, the Holland case was also an opportunity to educate the community about the difference between latent and active TB. “That kind of helped our mission,” Haptu said.

Melis Celmen, project manager for the CDC grant, said one challenge will be overcoming the stigma tuberculosis has among immigrants.

Deborah A. McManus, the TB clinic’s nurse manager, said: “We have to ensure they understand that all they did was breathe.”

I would hold mine if I were you.

--more--"Maybe we should keep the Haitians here for their own health.UPDATE:

"The field is plagued by strange economics. Companies making such drugs rarely see strong profits because they’re mostly reaching poor patients in the developing world. In recent years, in fact, two major pharmaceutical companies — Wyeth (now Pfizer) and Sanofi — withdrew from the antivenom market, citing the inability to make a profit. The new breed of snakebite entrepreneurs insist science — and possibly startups — can save the day...."Or are they just $nake oil $ale$man?

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